Provider First Line Business Practice Location Address:
1143 HILLTOP DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-224-1752
Provider Business Practice Location Address Fax Number:
530-224-1753
Provider Enumeration Date:
09/20/2005